A Sort-Of House Call

A doctor in our office just told me the funniest story, and I just had to share it with you.

Apparently, he was getting lunch at the Burger King down the street, when a patient of his noticed him. He seemed extremely glad to see his doctor at such an informal setting. "Even you eat at Burger King? It must be healthy! "

This was a doctor who usually wouldn't be caught dead at a fast food restaurant. He was actually picking up lunch for our receptionist as part of losing a bet. As part of the deal, he couldn't go through the drive-thru, either, he had to go inside. (Have I ever mentioned just how nice our doctors are?)

So he was friendly with this patient, and the lines were all long, leaving them both with plenty of time to socialize. The patient suddenly went quiet, and seemed to hem and haw. The doctor sensed the man was trying to say something but couldn't. Finally, the patient quietly said something about a rash on his genitalia.

The doctor was just about to suggest that he make an appointment, when the man dropped his trousers. Right there--in the line at Burger King! The patient immediately realized what he'd done and pulled up his drawers. He headed out of the restaurant like a shot, saying he would call the office. The doctor just shook his head and laughed it off, as did everyone around him.

When he got back to our office, the doctor gave the receptionist her lunch and said he would bet her french fries that he knew the name of the patient who just called to make an appointment. He was done eating the fries by the time he told her how he knew.

Clearing the Air

First, I want to address the response to my previous blog regarding the Union Pacific decision. I make no apologies for either my politics or my opinions. I want this blog to be mainly about questions arising from the office practice of medicine, but I also feel it's fair and appropriate to discuss medical issues of the day.

I enjoy reading the opinions of my fellow professionals, and I would hope that you would all accord me the same respect that I give you. If you disagree, please leave a comment and tell me why, but not in a mean or insulting tone. I consider myself lucky to have such thoughtful people at my disposal. Believe me when I say that I know I'm not always right, and that a day doesn't go by when I don't learn (and feel humbled by) something new.

For example, in the case of the post where I considered telling a doctor colleague he was behaving in an unhealthy manner, I was reprimanded by many readers who felt I was totally crossing a line. In the end, I knew they were right. Another time a reader accused me of malpractice for the poor way I had treated a frequent patient who was a chronic complainer. While I would argue that the quality of this patient's care wasn't compromised, I cannot argue with the fact that the spirit of care was violated.

I want to be better at what I do, and this blog--and all of you, by extension--has helped me to do just that. Thank you.

Just a quick note from this article which speculates that Baby Boomers are less healthy than their middle-aged predecessors:

"Significantly, fewer such middle-aged people in 2004 than in 1992 rated their health highly. More of them rated pain as a regular problem. And a higher percentage had trouble climbing stairs or walking a few blocks."

The study was far from official, and some speculate that Boomers are just more cognizant of health issues than previous generations, so the statistics could just reflect a greater awareness. I tend to think that's probably true. America is a funny country. On the one hand, healthy lifestyles have never been so promoted to the general culture, and yet on the other, we face rampant obesity and the attendant health problems therein.

As always, I wonder what do you think?

When Judges Decide Healthcare

I was appalled at the recent decision by the judges in the Union Pacific case. They decided that the two women who sought to have contraception included as part of their insurance coverage weren't entitled to it. Here's what they said:

"Union Pacific’s health plans do not cover any contraception used by women such as birth control, sponges, diaphragms, intrauterine devices or tubal ligations or any contraception used by men such as condoms and vasectomies. Therefore, the coverage provided to women is not less favorable than that provided to men.”

Somebody should get the two judges who came to this decision into a sex education course pronto! Men cannot get pregnant, so the importance of contraception for them is hardly the same. Does it surprise anyone that these two judges were appointed by republican presidents, while the lone dissenting opinion was appointed by a democrat?

This shouldn't be a turf war between conservatives and liberals. It's a common sense issue. Unfortunately, many employers don't want birth control included in health plans due to religious convictions and/or the extra cost involved. Sadly, if mistakes are made and contraception is not used, it is the woman who potentially bears the brunt of the decision.

Of course, Union Pacific had no objection to Viagra and Rogaine being included as part of their healthcare plan. After all, when it comes to contraception, looking good and being able to perform are far more important. What are your thoughts?

Generic Advice

For most people, it's a given that generic drugs are vastly cheaper. However, according to a new article in the Wall Street Journal, this ain't necessarily so:

"At a time when policy makers are searching for ways to cut health-care costs, generic drugs are often viewed as one of the most straightforward solutions. But...prices can vary wildly, and may not be nearly as cheap as expected. Generics of a number of...notable drugs that came off patent recently -- including the antidepressant Zoloft, the antibiotic Zithromax and allergy drug Flonase -- have...so far failed to deliver big savings in many cases."

The article noted how the prices for the generic version of widely-prescribed Zocor, a cholesterol-lowering drug that lost its patent protection last year, were not significanly lower at major drug chains like Walgreens and CVS. 30 tablets of a 20-miligram dose cost over $100 at both places, whereas Sam's Club had it available for $6.97!

Why? Well, of course, the drug stores note that they make most of their profits through prescription drugs. I think it's telling that many of the stores contacted by the reporter changed their prices or said they would be reviewing them, no doubt out of embarrassment.

Of course, for insured people who benefit from getting the lowest co-pays for generic drugs, this isn't a noticeable problem. Insurance companies get discounts for the drugs that stores do not. It's the 46 million uninsured Americans who potentially suffer. The article suggests that people research their options online first, then call to verify the prices listed.

In other words, just because something is generic, doesn't mean it's cheap.

Staff Problems

One of my employees is going to medical school. She is in her mid-40s and does a fantastic job. There is just one problem: she calls one of the younger doctors by his first name.

Outside of the office, a lot of us will socialize on occasion, and there are no formalities in terms of how people are addressed. But in the office, in front of staff and especially patients, the doctors don't go by their first names. It is Dr. ________. To do otherwise shows a lack of respect.

I've talked to the woman-in-question about this several times, and for a while she follows protocol. Then she will invariably slip, and the doctor-in-question will pull me aside to complain. I am quickly reaching a crossroads over this, as her behavior ultimately reflects on my leadership. I know it sounds crazy, but I am on the verge of firing her for not properly addressing a staff doctor. Has anyone else had a similar experience?

As if that wasn't enough, another employee who I paid an agency $4,000 in fees to hire has just given her notice after only working in our office for 5 months. I've heard of other offices who make a deal under-the-table with their potential employees to circumvent paying the agency fees. I refuse to do something so unethical, but I have to admit it's very tempting.

On a final note, I'd like to thank everyone who took the time to respond to my previous post about the doctor at my office with diabetes. I wrote it in a very emotional state, and by the next morning I realized it was something that just wasn't my business. Or rather, our relationship involves business, and that precludes me from commenting to him about something so personal.